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South Dakota rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $86.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.76 / $2.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $1.84 / $2.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.94 / $6.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.37 / $2.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.50 / $4.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $1.90 / $1.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74